Skin Picking: OCD and the Skin, Part 2.

About skin picking

Dermatillomania is a disorder that involves compulsively picking the skin. It can be pimples, scabs or another mark that needs to be picked at to feel good about the perceived skin problem. It has been argued that the disease is more similar to a drug dependency or impulse control disorder (like gambling) rather than obsessive compulsive disorder, as both dermatillomania and trichotillomania have a feeling of satisfaction after performing the compulsion.

Is it the same as hair pulling?

Hair pulling or trichotillomania has been distinguished in the literature as a separate condition, but they often go hand in hand. Hair pulling is the compulsion to pull hairs out of the body, usually on the head, eyelashes and eyebrows. It can cause baldness, embarrassment and social isolation.

Why scabs and pimples are important

Although they may be unsightly, scabs and pimples are part of the body’s healing mechanisms. Scabs cover up what would be open wounds, and allow a healing environment to lay down new tissue in two stages: granulisation (red) and epithelisation (pink). Removing a scab opens up the wound to infection and dryness, delaying wound healing. Repeated picking at a scab will cause it to be filled in with hard, white, fibrous scar tissue.

Pimples (acne) are the body’s way of combating bacteria that have proliferated around a hair follicle. Pimples that have yellow or green pus are not particularly pretty, but you are better to treat the pimple with a medicated concealer than to squeeze it. Squeezing pimples can lead to infection, scarring and also delay wound healing.

If the appearance of either of these makes you feel uncomfortable, you can purchase blemish cover up spots, bandaids or use medicated concealer (such as Dermalogica’s mediBac Concealing Spot Treatment) on the affected area.

What are the complications

The urge to pop pimples or pick scabs can be overwhelming for some people, because doing so relieves anxiety, however such behaviour can interfere with everyday life. This is where it becomes a skin picking disorder. Such a disorder can lead to localised infection, scarring and sepsis- blood poisoning, that can lead to tissue debridement (removal), limb amputation and is life threatening. Many people with sepsis die within one year after illness.

To repair the damage from skin picking, major surgery may be required. There have been reports of individuals who have had such strong urges to pick their skin that they have needed major skin grafts to their face, and have exposed a major artery on their neck. The risk of infection for large open wounds is great, and the downtime during recovery can have a significant impact on the daily life of the individual with skin picking disorder.

This disorder can also have a significant impact on the emotional and mental wellbeing of the individual and their family. People may feel ashamed of their appearance and are often mistaken for drug addicts or having HIV/AIDS. Anxiety, depression, social isolation and low self-esteem may be associated with dermatillomania. It is important to support someone with a skin picking disorder if they want to seek help.

Treatment for skin picking

Three types of therapies have been identified as useful in the treatment of dermatillomania and trichollitomaia. Cognitive behaviour therapy [CBT], acceptance and commitment therapy [ACT] and selective serotonin reuptake inhibitors [SSRIs] have all had positive results in the management of skin picking disorders. Pharmacotherapy combined with therapy is often more successful in treating mental health disorders, rather than one therapy treatment on its own.

Seeing a dermatologist can be useful for skin picking disorder treatment, as they can help treat acne, scars and other skin disorders. They can also advise on the best tips, products and medications for skin to help it heal and prevent further damage.

Make an appointment

If you have questions or require information about managing acne, contact your local doctor who will arrange for you to see a dermatologist.

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We are Dietitians and Nutritionists, Speech Pathologists and Skincare Specialists. We see adults and children from our office in Randwick. Passionate about health and wellbeing, we write about issues relevant to our clinical practice.